If your numbers are creeping in the wrong direction or cholesterol problems run in your family, you may be thinking of turning to statin drugs or natural antidotes, such as red yeast rice, a fermented rice product used in Chinese medicine.
But recent research has called those solutions into question. One study showed that statins increase the risk of developing diabetes by 9 percent, while University of Pennsylvania researchers found that some red yeast supplements have little of the active ingredients that help lower cholesterol (a few even contain a toxic fungus).
It may be time to talk to your doctor about whether changes in your habits and routine could work for you. Fortunately, you have powerful cholesterol-fighting weapons right in your kitchen.
"Research has shown that lifestyle changes, especially in your diet, are very effective for lowering blood cholesterol," says Jana Klauer, M.D., a physician specializing in metabolism and nutrition in New York City.
Getting the Wrong Foods Out, Right Foods In
Dropping excess weight and getting physically active are the foundations to lowering the LDL "bad" cholesterol and raising the HDL "good" kind.
It's also key to minimize saturated and trans fats, found in red meats, full-fat dairy, and processed foods made with hydrogenated vegetable oils.
But a cholesterol-friendly diet isn't just about cutting foods out; it's about getting more of the right things in. Scientists have discovered that certain foods -- dubbed "the portfolio diet" for its array of benefits -- act like cholesterol-sucking vacuums, removing the excess from the body before it lodges dangerously in artery walls.
In fact, when people in studies ate a diet rich in these foods, their LDL levels plummeted 35 percent on average.
"The results are as dramatic as if they had been on a first-generation statin drug," says Cyril Kendall, Ph.D., a professor of nutrition and metabolism at the University of Toronto and a lead researcher in the studies.
To improve your cholesterol levels naturally (even if you're on meds now), go out of your way to eat these foods.
Pistachio Nuts and Almonds
These two are proven reducers of LDL cholesterol, although all nuts, including walnuts and cashews, have similar effects, Kendall says. Rich in protein, nuts can be a quick snack or a crunchy complement to dried fruit, morning cereal, or salads.
Because their calories add up quickly, "eat a handful, not a can full," cautions Philadelphia dietitian Althea Zanecosky, R.D. She also suggests amping up your PB&J by switching to almond or pistachio butter. Aim for a daily total of 1.5 grams (that's about 28 almonds).
Oatmeal, Barley, and Eggplant
Soluble fiber is the superstar here. It forms a gel-like substance in the intestines that stops cholesterol from passing into the blood. Boosting soluble fiber by 5 to 10 grams per day (a cup of cooked oatmeal has 2 grams) drops LDL by up to 5 percent, according to the National Institutes of Health.
Make oatmeal or hot barley cereal a breakfast staple (cholesterol-busting bonus: Throw in almonds and soy milk). Add barley to soups or stews, or saute this nutty-flavored grain with onions for a tasty side dish.
Roast or grill eggplant; if you can't resist the classic parmigiana, bake (don't fry) the slices, and swap full-fat for low-fat cheese, suggests New York City dietitian Susan Kalish, R.D.
Another food high in soluble fiber, protein, and various minerals, beans are affordable and versatile. Canned beans are ultraconvenient (rinse them to remove excess salt), but you can also soak and cook a batch of dried ones on Sunday to enjoy throughout the week, Kalish says.
She advises experimenting: Try chickpeas in a salad or pureed cannellini beans (with lemon juice and olive oil, and, if you like, roasted red peppers or dill) as a vegetable dip.
Whether it's tofu, soy milk, soy yogurt, edamame, or foods that list "soy protein" on their labels, all soy foods help lower LDL levels, Kendall says.
Mix and match several to reach the portfolio diet goal of 25 grams daily: Have soy milk with lunch, tofu for dinner, and boiled edamame as an afternoon snack.
As a bonus, many soy products replace foods high in saturated fats such as ground meats (swap beef for extra-firm tofu in chili, on pasta, or in a hamburger bun) and whole-fat milks and yogurts, "so you get a double effect," Kendall says.
These phytochemicals, which occur naturally in plants, block cholesterol's absorption into the blood -- but you'd have to eat an awful lot of vegetables to get the two grams recommended daily.
"Someone on a heavily plant-based vegan diet probably gets only one-half to one gram a day," Kendall says.
Lucky for us, store shelves are now full of products fortified with these compounds. In addition to spreads like Benecol and Promise Activ, there are added sterols in some brands of orange juice, milk, olive oil, low-fat cheese, and bread. (Sterols are loudly touted on the labels, so no squinting is required.)
In one study, plant sterols accounted for approximately one-third of the total drop in LDL levels in people following the portfolio diet.
The Basics of Cholesterol Counts
Some cholesterol is crucial for good health; our bodies use the waxy substance to coat our cells and to manufacture certain vitamins and hormones. But in a classic case of too much of a good thing, the excess cholesterol is stashed in our artery walls, building up over time and potentially leading to heart attack or stroke.
Because high blood cholesterol is symptomless, you need a fasting blood test to detect it. Doctors check your total cholesterol, which includes LDL (low-density lipoprotein), the molecules that carry cholesterol around the body (hence the nickname "bad cholesterol"), and HDL (high-density lipoprotein), the particles that return some of the extra to the liver for disposal (that's why it's "good").
Ideal total cholesterol for women is under 200 mg/dl, LDL below 100 and HDL at or above 60. However, estrogen can alter your levels. Doctors have known that pregnancy and the Pill raise cholesterol, but a recent study found that levels vary as much as 19 percent during a woman's cycle (it's highest mid-cycle, around ovulation).
"If you get a high reading, ask your doctor about repeating the test at a different time of the month so you aren't put on statins unnecessarily," says Jana Klauer, M.D.